Eating disorders: are coaches to blame?

Sportswomen are five times more at risk of eating disorders than the general population. That’s the implications of a new study from Spain – the first to investigate the prevalence of eating disorder and risk behaviours in Spanish female athletes.

A total of 283 elite sportswomen competing in 20 different sports completed two standard questionnaires on eating disorders and two further inventories designed to assess the influence on eating disorders of exposing the body in public and pressure from coaches about eating habits, weight and physical appearance.

Key findings were as follows:

• One of the standard questionnaires – the Eating Disorders Evaluation Questionnaire – found that 2.5% of the sample fitted the diagnostic criteria for anorexia nervosa, while 20.14% probably had bulimia nervosa. This is five times the prevalence found in the female Spanish population of similar age;
• As might be expected from previous research, athletes competing in rhythmic sports – gymnasts and skaters – showed a high prevalence of eating disorders, with 6% fitting the criteria for anorexia and 19.4% for bulimia;
• But it was sailors, rowers and canoeists who had the highest prevalence of bulimia (33%), closely followed by swimmers (31.6%), while athletics and long distance running produced the lowest prevalences of 9.1% and 6.7% respectively;
• Subjects considered to display their bodies in public – swimmers, gymnasts and skaters – had higher (ie worse) scores on the Eating Attitude Test than other athletes, but high level athletes were less at risk than those of lesser ability;
• Pressure from coaches regarding eating, physical appearance, weight and performance was significantly linked with the risk of bulimia.

‘It appears to be particularly important,’ conclude the researchers, ‘that athletes [in certain sports] should be supervised clinically and that the conduct of their coaches and others in charge of sports activities should be monitored.’
Int J Sports Med 2005;26:693-700